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Lymphomatoid Papulosis Histopathologically Simulating Angiocentric and Cytotoxic T-cell Lymphoma: A Case Report

Wu, Wei-Ming MD; Tsai, Hsiang-Ju MD

The American Journal of Dermatopathology: April 2004 - Volume 26 - Issue 2 - p 133-135
Extraordinary Case Report
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Abstract: We report a patient presenting with a 20-year history of recurrent papulonecrotic lesions in which skin biopsy shows extensive vascular destruction. Atypical lymphoid cells surrounding the dermal vessels had a CD3+, CD4, CD5, CD8+, CD20, CD30+, CD56+, TIA-1+, and granzyme B+ immunophenotype implicating a natural killer/T origin. In situ hybridization was negative for Epstein-Barr virus transcripts. Analysis of T-cell receptor-γ gene of 2 separate biopsy specimens detected an identical clone. The patient was treated with low-dose methotrexate and achieved complete resolution in a month. According to the clinical course, immunophenotype, clonality analysis and the excellent response to methotrexate, we conclude that this is an unusual case of lymphomatoid papulosis. We believe that this unusual presentation needs to be distinguished from other aggressive lymphomas, including the natural killer/T-cell and cytotoxic T-cell subsets.

From the Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan.

Reprints: Wei-Ming Wu, MD, Department of Dermatology, Chang Gung Memorial Hospital, 199 Tung-Hwa North Road, Taipei 105, Taiwan (e-mail: weimin1970@yahoo.com.tw).

© 2004 Lippincott Williams & Wilkins, Inc.